Eye Exams for Thyroid Eye Disease

Reviewed by: HU Medical Review Board | Last reviewed: October 2021

Because thyroid eye disease (TED) is rare, seeing a TED specialist is essential in making sure you get the right treatment. This helps reduce your risk of vision problems or complications. These specialists are ophthalmologists or eye doctors with specialized training in diagnosing and treating TED.1

When you see a TED specialist, they will perform a series of eye exams to diagnose and help you manage the condition.

Vision tests

At the beginning of an eye exam, your TED specialist will ask for your medical history and if you have been experiencing any vision problems. During the eye exam, your TED specialist can perform a number of different tests. Based on the results of these tests, your doctor can determine if you need any follow-up vision tests. These tests help evaluate your overall eye health.1

Vision tests are used to measure how well you see. This includes things like whether you can see symbols or alphanumeric characters, are experiencing distorted vision, and how wide your field of vision may be.2

A visual acuity test is the standard eye chart exam that measures how well you can see a letter, number, or symbol from a certain distance. The doctor will often have you read lines with each eye individually while the other eye is covered. They may also ask you to read lines with both eyes.2

Eye measurements

Swelling of the fat and tissues behind the eye from TED can cause your eyes to push or bulge forward in the socket. This can happen to one or both eyes. Your doctor may call this proptosis (prop-toe-sis) or exophthalmos (ek-sof-thal-miss). Eye bulging occurs in about 6 out of 10 people with TED.1

Your TED specialist will measure the amount of eye bulging with a special ruler called an exophthalmometer (ek-sof-thul-mom-i-ter).1

Eye pressure readings

Eye pain and pressure are common in TED, especially when moving the eyes. Pain may be felt in, around, or behind the eyes. Looking upward, to the side, or downward may make the pain worse.1

Swelling from TED can cause increased pressure in the eye. Your TED specialist will check this pressure with a procedure called tonometry. First, your doctor will put numbing drops in your eyes. Next, the doctor will use a blue light device to gently touch the surface of your eye. This device applies a small amount of pressure to your eyes, allowing your doctor to measure the exact amount of pressure inside each eye.1,3

Visual field testing

Visual field testing is a way for your TED specialist to measure how wide your vision is and see if you are able to focus on a central object. TED can cause blurry vision or cause images to look out of focus. Visual field testing can help your doctor look at how much vision loss might have occurred over time.4

Eye muscle function testing

Because TED affects the muscles of the eye (extraocular muscles), your TED specialist will perform eye muscle function testing to see how well your eyes can move. Your doctor will hold a pen or other object about 16 inches away from your face. You will follow the object with your eyes, holding your head still while your doctor moves the object in several directions.5


As part of your eye exam, your TED specialist will use an ophthalmoscope (off-thal-muh-skohp) to look for signs of damage to the optic nerve. An ophthalmoscope is a tool that helps visualize the back of the eye and optic nerve. The eye doctor may give you eye drops to enlarge (dilate) your pupils to get a better look at the nerve at the back of your eye.2,6

You might first see your primary doctor before being seen by a TED specialist. While any doctor can diagnose and treat TED, only TED specialists have special training in treating and managing the condition. Your TED specialist may recommend additional eye exams or testing to get you on the right path of your treatment journey with TED.

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